Tendons connect muscles to bones and span across joints, enabling those joints to be moved. One of the most important tendons in the lower leg is the tibialis posterior tendon. The muscle is deep in the calf, and becomes a tendon before passing immediately behind the bone on the inside of the ankle and attaching to bones in the instep, most particularly the navicula.
The tibialis posterior tendon helps support the arch of the foot and provides stability when pushing through the toe-off part of the walking cycle. If this tendon becomes inflamed, degenerated or torn, it can become “dysfunctional” leading to pain on the inner aspect of the ankle and a gradual loss of arch height (flatfoot deformity).
Tibialis posterior tendon dysfunction can occur in people of any age, but is most common in women over 50 years of age. Risk factors include:
The diagnosis is based on both a history and a physical examination. You may be asked to stand and walk to view how your foot functions. As the condition progresses, the heel tilts outward and the forefoot rotates in the same direction. There is local tenderness and swelling, weakness of hindfoot rotation and loss of joint movement. Standing X-rays, and an MRI of the foot may be required.
Without treatment and over time, the flatfoot that develops from tibialis posterior tendon dysfunction eventually becomes rigid. Arthritis develops in the hindfoot. Pain increases and spreads to the outer side of the hindfoot. There is usually a limp and wearing shoes may be difficult.
The treatment will depend on how far the condition has progressed, age, general health and activity level. In the early stages, tibialis posterior tendon dysfunction can be treated with physiotherapy, non-steroidal anti-inflammatory medication, and splintage of the foot for 6 weeks in a CAM-boot to rest the foot. Shoe inserts (insoles) should incorporate a heel wedge and arch support. If the condition is advanced, a custom-made ankle-foot orthosis may be helpful. If non-operative treatment doesn’t work ( and this is often the case), an operation may be needed. Several procedures can be used to treat tibialis posterior tendon dysfunction. Often, more than one procedure is performed at the same time. Treatment will be individualised.
Surgical options include:
All surgical procedures involve risks. The information provided here is for general educational purposes only. For specific advice regarding tibias posterior tendon dysfunction, please book an appointment with Dr Newman.